Special Care for Premature Babies - Neonatal Intensive Care At St. Joseph's
Premature babies require special care. Dr. Phillip Cheng, neonatologist, discusses the neonatal intensive care unit.
Featured Speaker:
Philip Cheng, MD
Dr. Cheng graduated from Virginia Commonwealth University, Medical College of Virginia in Richmond, VA and then joined the UCSF Fresno Medical Education Program to complete his residency in Pediatrics. He went onto UC San Diego to complete his Fellowship in Neonatology where he served as Chief Fellow and was presented with the prestigious Pediatric Fellow of the Year award. Additionally, Dr. Cheng has completed specialized training in functional echocardiography, which will allow physicians to make rapid decisions about a baby’s circulatory system. Transcription:
Special Care for Premature Babies - Neonatal Intensive Care At St. Joseph's
Bill Klaproth (Host): St. Joseph’s Nursery Intensive Care Unit or NICU cares for newborn infants throughout the southwest and serves as the first home for nearly 800 premature babies each year. And here to talk with us about neonatal intensive care at St. Joseph’s is Dr. Philip Cheng, a neonatologist and Chair of Pediatrics at Dignity Health. Dr. Cheng, thanks for joining me today.
Philip Cheng, MD (Guest): Heh Bill, thanks for having me.
Host: You bet. So, let’s get into this. First off. I’m sure you get this question a lot. Can you explain to us what a neonatologist is?
Dr. Cheng: No, no problem Bill. So, I get that question asked a lot. Probably 95% of people I meet in public ask me what a neonatologist is. So, to simply put it, is to- we are basically general pediatricians that have undergone special training. To be exact, we have undergone three more years of training after our general pediatrics training and we become neonatal intensive care doctors that care for the sick babies. Our range of babies that we take care of are usually ranged from anywhere from prematurity down to 24 weeks, all the way up to full-term.
Host: So, tell us how does the NICU differ than from a regular ICU?
Dr. Cheng: Well, the NICU differs from a regular ICU is that the population that we take care of. Babies as you know, they come with a different set of mechanics and body physiology that’s not known anywhere in the field of medicine besides neonatology. How this differs is that the babies are – they are just not little adults. They actually have their own set of body physical functions and they also have – in the NICU we also take care of premature babies. Premature babies on that aspect, are not designed by nature to be outside the womb. So, when mothers who have undergone stressful situations or have undergone certain circumstances where they are not able to take care of the baby, in certain incidents and they have to deliver; we are there to provide help to continue the growth and processes to help babies when they are born. Specifically, with premature babies, their organs are really immature. So, with that in mind, depending on the degree of immaturity, their body needs a lot of help. Most commonly, one of the things we look out for is metal lung disease lung disease. With lung disease, we have different modalities in the NICU that can help out with that.
Host: So, that makes sense. You were mentioning lung disease. What other serious conditions or complicated issues are the primary reasons babies receive treatment in the NICU?
Dr. Cheng: Other treatment conditions can vary by different organ functions. Sometimes some babies can be born with certain cardiac conditions such as abnormally structured hearts where they may need surgery in the future. Or some babies are born with decreased gut function where their intestines are not – need a little bit more time and support in order to function properly towards a mature function. Other things we watch out for is that we also watch for infection. With these population of infants, their immune system is quite vulnerable. They essentially don’t have the same immune function as adults. Meaning that we call them immunocompromised. Meaning that their immune function – and their responses is not as robust. So, therefore, to you and I, we can probably weather the most common infection the cold, but for these babies, with a delicate population, they don’t weather the cold and sicknesses very well. So, they usually need extra help and that’s what we are here for.
Host: So, to help you with the care of these precious infants, tell us about the state-of-the-art technology and advanced life-saving equipment that you use.
Dr. Cheng: So, part of the life-saving equipment– one of our bread and butter is with pulmonary diseases is that we have many modes of ventilation here at St. Joseph’s. What I mean by ventilation is that there’s ventilation refers to the actual breathing exchange of respiratory gases that occur just like when we breathe out, we breathe out the carbon dioxide. So, with that mode, we start out with nasal oxygen – nasal CPAP known as continuous positive airway pressure. For the babies that can go through this – that looks like a nasal device that goes through the nose to help the babies exchange air.
When babies are in more need of support, what we do is we do a procedure called intubation. What that entails is that we gently insert a breathing tube into the right position in the airway to provide breathing support. After the intubation procedure is performed, we connect the breathing tube to a machine. Now, that’s where the state-of-the-art technology comes in. There are different modes ventilation we have.
The first mode is that we start with going from lowest to highest. We have conventional ventilation that are designed for neonatal infants and after that, we have high frequency. High frequency allows us to take care of the really, really sick infants that need a really lot of help. Usually the infants that need a lot of help are usually those infants that are born very premature, that the lungs are not quite ready to function yet in the real world. So, we are there to help and give them support.
In addition, we also have one mode of ventilation that is very unique to us here at St. Joseph’s. We call it NAVA for short, N-A-V-A. What NAVA stands for it stands for Nearly Adjusted Ventilatory Assist and this technology is very special. I have actually brought it from my previous university academic experience research and brought it over and implemented it into clinical practice here at St. Joseph’s. What NAVA does is that there’s a special catheter that can detect the electromyogram movement of the diaphragm. So, essentially, it detects electrical activity of the muscles of the diaphragm. And with this, being that the diaphragm is the biggest muscle for breathing, we use that signal and synchronize it with the breathing machine for the infants. What research studies have shown is that this mode of ventilation has helped infants to breathe easier, make them more comfortable and therefore, provides better outcomes.
One of the outcomes we have seen at St. Joseph’s is better times – less time with a breathing tube in their mouth and therefore that leads to better outcomes especially with airway and also less chances of infection.
Host: This technology is just amazing. So, Dr. Cheng I imagine for someone listening to this podcast, they have an infant that is in the NICU or potentially a grandparent that has a grandchild in the NICU; can you tell us the difference of the level of care then between newborn care and NICU care?
Dr. Cheng: Yes, definitely. So, newborn care refers to the care of the newborn after they are born. Normally, these newborns, what defines a newborn population are term infants that are healthy, have no issues and they can be fine with no intravenous fluid support or no oxygen support. Now, when infants need help such as they need medicines such as antibiotics or they need intravenous fluids to help with their metabolic functions in their body or they need respiratory support whether it be as simple as an oxygen through the nose; that kind of steps of the game for bring a newborn care into the NICU realm. So, what defines the NICU realm from the newborn is just the definition of whether the kid is ill or not. It it’s a healthy term infant, usually I’m the last person to be called. But if it’s a sick infant, I’m usually the first line of defense.
Host: Got you, so after care is done, and the young child is healthy enough for discharge; can you tell us about the parent room to help ease the transition from hospital to home before discharge?
Dr. Cheng: Oh yes, definitely. So, a lot of times especially with premature babies that have been in the NICU for up to one or two months; they have never seen home at all. And the parents have never been in the home environment with them. This sometimes can create a lot of anxiety and a lot of unknown things for parents. So, to help with the transition from the hospital to the home; we have a program here at St. Joseph’s to help with what we call the rooming in program to help parents ease the transition towards discharge. What this consists of is that when we know that the patient is going to be discharged the day after tomorrow or tomorrow; what we do the night before is that we would have the parents stay in one of our rooms, the individual single room with the baby, with nursing care on stand by and this kind of simulates what it would be like at home with the baby with no monitors, but however nursing care will be on stand by just in case if anything were to happen.
What this does is that it allows the parents to simulate what an environment of the home environment would be like outside the NICU. And from the feedback I’ve gathered from parents; they tremendously love this program. Any baby can qualify for this program. So, whether it be a term baby or a premature baby, if the parents request that they would love to have a rooming in session before they go home just to gain more confidence and decrease anxiety, we definitely offer it to the parents.
Host: What a very important program. And Dr. Cheng thank you for all that you do and thank you for your time today. We appreciate it. For more information, please visit www.dignityhealth.org, that’s www.dignityhealth.org. This is Hello Healthy a Dignity Health podcast. I’m Bill Klaproth. Thanks for listening.
Special Care for Premature Babies - Neonatal Intensive Care At St. Joseph's
Bill Klaproth (Host): St. Joseph’s Nursery Intensive Care Unit or NICU cares for newborn infants throughout the southwest and serves as the first home for nearly 800 premature babies each year. And here to talk with us about neonatal intensive care at St. Joseph’s is Dr. Philip Cheng, a neonatologist and Chair of Pediatrics at Dignity Health. Dr. Cheng, thanks for joining me today.
Philip Cheng, MD (Guest): Heh Bill, thanks for having me.
Host: You bet. So, let’s get into this. First off. I’m sure you get this question a lot. Can you explain to us what a neonatologist is?
Dr. Cheng: No, no problem Bill. So, I get that question asked a lot. Probably 95% of people I meet in public ask me what a neonatologist is. So, to simply put it, is to- we are basically general pediatricians that have undergone special training. To be exact, we have undergone three more years of training after our general pediatrics training and we become neonatal intensive care doctors that care for the sick babies. Our range of babies that we take care of are usually ranged from anywhere from prematurity down to 24 weeks, all the way up to full-term.
Host: So, tell us how does the NICU differ than from a regular ICU?
Dr. Cheng: Well, the NICU differs from a regular ICU is that the population that we take care of. Babies as you know, they come with a different set of mechanics and body physiology that’s not known anywhere in the field of medicine besides neonatology. How this differs is that the babies are – they are just not little adults. They actually have their own set of body physical functions and they also have – in the NICU we also take care of premature babies. Premature babies on that aspect, are not designed by nature to be outside the womb. So, when mothers who have undergone stressful situations or have undergone certain circumstances where they are not able to take care of the baby, in certain incidents and they have to deliver; we are there to provide help to continue the growth and processes to help babies when they are born. Specifically, with premature babies, their organs are really immature. So, with that in mind, depending on the degree of immaturity, their body needs a lot of help. Most commonly, one of the things we look out for is metal lung disease lung disease. With lung disease, we have different modalities in the NICU that can help out with that.
Host: So, that makes sense. You were mentioning lung disease. What other serious conditions or complicated issues are the primary reasons babies receive treatment in the NICU?
Dr. Cheng: Other treatment conditions can vary by different organ functions. Sometimes some babies can be born with certain cardiac conditions such as abnormally structured hearts where they may need surgery in the future. Or some babies are born with decreased gut function where their intestines are not – need a little bit more time and support in order to function properly towards a mature function. Other things we watch out for is that we also watch for infection. With these population of infants, their immune system is quite vulnerable. They essentially don’t have the same immune function as adults. Meaning that we call them immunocompromised. Meaning that their immune function – and their responses is not as robust. So, therefore, to you and I, we can probably weather the most common infection the cold, but for these babies, with a delicate population, they don’t weather the cold and sicknesses very well. So, they usually need extra help and that’s what we are here for.
Host: So, to help you with the care of these precious infants, tell us about the state-of-the-art technology and advanced life-saving equipment that you use.
Dr. Cheng: So, part of the life-saving equipment– one of our bread and butter is with pulmonary diseases is that we have many modes of ventilation here at St. Joseph’s. What I mean by ventilation is that there’s ventilation refers to the actual breathing exchange of respiratory gases that occur just like when we breathe out, we breathe out the carbon dioxide. So, with that mode, we start out with nasal oxygen – nasal CPAP known as continuous positive airway pressure. For the babies that can go through this – that looks like a nasal device that goes through the nose to help the babies exchange air.
When babies are in more need of support, what we do is we do a procedure called intubation. What that entails is that we gently insert a breathing tube into the right position in the airway to provide breathing support. After the intubation procedure is performed, we connect the breathing tube to a machine. Now, that’s where the state-of-the-art technology comes in. There are different modes ventilation we have.
The first mode is that we start with going from lowest to highest. We have conventional ventilation that are designed for neonatal infants and after that, we have high frequency. High frequency allows us to take care of the really, really sick infants that need a really lot of help. Usually the infants that need a lot of help are usually those infants that are born very premature, that the lungs are not quite ready to function yet in the real world. So, we are there to help and give them support.
In addition, we also have one mode of ventilation that is very unique to us here at St. Joseph’s. We call it NAVA for short, N-A-V-A. What NAVA stands for it stands for Nearly Adjusted Ventilatory Assist and this technology is very special. I have actually brought it from my previous university academic experience research and brought it over and implemented it into clinical practice here at St. Joseph’s. What NAVA does is that there’s a special catheter that can detect the electromyogram movement of the diaphragm. So, essentially, it detects electrical activity of the muscles of the diaphragm. And with this, being that the diaphragm is the biggest muscle for breathing, we use that signal and synchronize it with the breathing machine for the infants. What research studies have shown is that this mode of ventilation has helped infants to breathe easier, make them more comfortable and therefore, provides better outcomes.
One of the outcomes we have seen at St. Joseph’s is better times – less time with a breathing tube in their mouth and therefore that leads to better outcomes especially with airway and also less chances of infection.
Host: This technology is just amazing. So, Dr. Cheng I imagine for someone listening to this podcast, they have an infant that is in the NICU or potentially a grandparent that has a grandchild in the NICU; can you tell us the difference of the level of care then between newborn care and NICU care?
Dr. Cheng: Yes, definitely. So, newborn care refers to the care of the newborn after they are born. Normally, these newborns, what defines a newborn population are term infants that are healthy, have no issues and they can be fine with no intravenous fluid support or no oxygen support. Now, when infants need help such as they need medicines such as antibiotics or they need intravenous fluids to help with their metabolic functions in their body or they need respiratory support whether it be as simple as an oxygen through the nose; that kind of steps of the game for bring a newborn care into the NICU realm. So, what defines the NICU realm from the newborn is just the definition of whether the kid is ill or not. It it’s a healthy term infant, usually I’m the last person to be called. But if it’s a sick infant, I’m usually the first line of defense.
Host: Got you, so after care is done, and the young child is healthy enough for discharge; can you tell us about the parent room to help ease the transition from hospital to home before discharge?
Dr. Cheng: Oh yes, definitely. So, a lot of times especially with premature babies that have been in the NICU for up to one or two months; they have never seen home at all. And the parents have never been in the home environment with them. This sometimes can create a lot of anxiety and a lot of unknown things for parents. So, to help with the transition from the hospital to the home; we have a program here at St. Joseph’s to help with what we call the rooming in program to help parents ease the transition towards discharge. What this consists of is that when we know that the patient is going to be discharged the day after tomorrow or tomorrow; what we do the night before is that we would have the parents stay in one of our rooms, the individual single room with the baby, with nursing care on stand by and this kind of simulates what it would be like at home with the baby with no monitors, but however nursing care will be on stand by just in case if anything were to happen.
What this does is that it allows the parents to simulate what an environment of the home environment would be like outside the NICU. And from the feedback I’ve gathered from parents; they tremendously love this program. Any baby can qualify for this program. So, whether it be a term baby or a premature baby, if the parents request that they would love to have a rooming in session before they go home just to gain more confidence and decrease anxiety, we definitely offer it to the parents.
Host: What a very important program. And Dr. Cheng thank you for all that you do and thank you for your time today. We appreciate it. For more information, please visit www.dignityhealth.org, that’s www.dignityhealth.org. This is Hello Healthy a Dignity Health podcast. I’m Bill Klaproth. Thanks for listening.